1518036490 NPI number — DR. CYNTHIA FOSTER D.D.S.

Table of content: DR. CYNTHIA FOSTER D.D.S. (NPI 1518036490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518036490 NPI number — DR. CYNTHIA FOSTER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTERSCHKOOR
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518036490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23077 GREENFIELD RD
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-905-5490
Provider Business Mailing Address Fax Number:
248-905-5439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23077 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-905-5490
Provider Business Practice Location Address Fax Number:
248-905-5439
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D0152340 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4188738 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: D152340 . This is a "LISENCE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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